Swine flu anxieties flood U.S. hospitals

On Long Island, N.Y., hospitals are scrambling to bring in extra workers to handle a 50 percent surge in visitors to emergency rooms. In Galveston, Texas, the local hospital ran out of flu testing kits after being overwhelmed with patients worried about having contracted swine flu.

At Loma Linda University Medical Center east of Los Angeles, emergency workers have set up a tent in their parking lot to handle a crush of similar patients. In Chicago, ER visits at the city's biggest children's hospital are double normal levels, setting records at the 121-year-old institution.

So far, few of the anxious patients have had more than runny noses. But the widening outbreak of swine flu, now being called H1N1 flu, is exposing a potentially critical hole in the nation's defenses.

Across the United States, local emergency care facilities are straining at the seams even though the outbreak is relatively small and the federal government has launched a mammoth disease-control effort -- dispatching anti-viral drugs to the states, attempting to contain the limited flu cases and beginning to develop a vaccine.

"It is a major Achilles' heel in our state of readiness," said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. "If we get a situation that is really out of hand with large numbers of people affected, I fear that our hospital and health care facilities simply won't have the materials or even the staffing to respond." Redlener and others are quick to point out that the so-called swine flu outbreak is still a long way from reaching such a critical stage.

Of the 133 cases of flu confirmed in the United States by the Centers for Disease Control and Prevention as of Thursday afternoon, only a handful had required hospitalization.

By contrast, the Department of Health and Human Services' moderate pandemic influenza model -- based on the last flu pandemic in 1968 -- envisions 90 million Americans becoming infected and 865,000 requiring hospitalization.

"If the outbreak stays in what I would characterize as its present mild form, I think we're in great shape," said James Bentley, senior vice president at the American Hospital Association. "The key question becomes how many people at any one time have the flu, and how many people have it severely."

Prompted by the recent global SARS and avian flu outbreaks, federal health officials and hospitals nationwide have been working to beef up preparations for possible disease outbreaks, helped by more than $2 billion in federal grants.

Hospitals have increased their supplies of staples like face masks, and many have trained employees to care for patients in the field.

In the past three years, the state of California has spent more than $400 million to upgrade its readiness, including purchasing three fully equipped mobile hospitals and nearly 7,200 ventilators to respond to an outbreak of respiratory illness.

"Very real progress has been made," said Dr. Richard Waldhorn, distinguished scholar at the Center for Biosecurity of the University of Pittsburgh Medical Center who recently completed a study of the federal preparedness initiative.

But Waldhorn and others said the serious gaps remain, which would quickly become apparent if the current outbreak worsens.

Even some public health officials acknowledge that supplies of critical equipment, such as ventilators, could be seriously taxed in a full-blown pandemic.

"When you get all states involved, it certainly is more of problem," said Dr. Gregg Pane, who directs the National Healthcare Preparedness Program at the Department of Health and Human Services.

Literally hundreds of millions of face masks would be required, said Waldhorn.

Across the country, there are already signs of strain.

In Galveston, workers at the hospital saw the flood of ER patients begin early Sunday morning following news reports of flu-induced closures across the border in Mexico, said Dr. Angela F. Gardner, an assistant professor of surgery and emergency medicine at the University of Texas Medical Branch in Galveston.

By that night, all but seven of the hospital's test kits were gone.

Gardner said they found no cases of the H1N1 virus. But the crowds have continued day after day, even as the hospital struggled to provide care to other patients.

"When they come in, we don't know who may be really ill and who isn't," said Gardner, who is also president-elect of the American College of Emergency Physicians. "You don't want to turn people away who may be sick."

In Chicago, Children's Memorial Hospital saw 394 children in its emergency room on Wednesday, more than double a typical day. And at midnight Thursday morning, some 80 children were waiting to be seen, mostly for flu symptoms, forcing the hospital to open new space to accommodate the crowd.

"That's virtually unheard of," said hospital spokeswoman Kathleen Keenan, who like many medical officials urged people to check with their primary care doctor before going to the ER.

In Los Angeles, several hospitals are also reporting increased numbers of patients to their emergency rooms, though the surge hasn't caused hospitals to begin diverting other patients, said Cathy Chidester, director of Los Angeles County's Emergency Medical Services Agency.

"Some of them don't even have the sniffles. They're just worried," Chidester said.

The strains on emergency rooms have been exacerbated by cutbacks across the health care industry in recent years, according to many experts. Between 1996 and 2006, the number of hospital emergency departments declined by nearly 10 percent, according to the CDC, even as demand for emergency services skyrocketed.

Hospitals are struggling too as a result of broader problems in the nation's health care sector. Since 2000, the number of beds at community hospitals nationally has dipped from 824,000 to around 800,000, according to the American Hospital Association.

And the recession has only accelerated the trend as hospitals shed nursing and other jobs to combat the economic downturn.

"The pressure has been to close excess beds and get lean," said Columbia's Redlener. "Lean is not your friend in a pandemic."